My wife, aged 51, had fever for about 15 days(from about 15 June 2008). She initially neglected the fever although she visited doctors with pain in joints and was treated with anti inflammation drugs and vtamins. She later on complained of fever and was treated with clarithromycin from 28 to 30 June 2008 and then with ofloxacin 400 mg for 3 days (till 2 July 2008).
Simultaneously she was treated with chloroquine(1g on 30 June, 500 mg on 1 July and 500mg on 2 July) She was also given 500 mg paracetamol and 100 mg nimusulide on 2 July for fever). Then on 2 July night at about 8.15 pm she had convulsions and was put under intensive care with diagnosis as status epilepticus. She regained consciousness after about 4 hours, but was in a confused state. Her state of confusion has continued for 48 hours. When she was hospitalised she was suspected to be infected with malarial parasite but the tests did not reveal active parasite infestation. No other causative organism could be found either in blood, stool or urine. Her CNS fluid was clear and did not show any growth of organism in culture. Her CT scan was normal, but ultra sound of abdomen showed hepatomegaly initially which later on resolved. In the hospital she was given quinine and taxim intraveneouly for 7 days. Her EEG was also reported to be normal.
She was discharged on 10 July, but was put on phenytoin 200 mg od from 7 th July. She broke out with fever again on 15 July and the fever lasted for about 4 days with daily temperature peaking in the afternoon (max 101 F). The face and body were covered with rash similar to measles which resolved by 20 July. The rash first appeared on the face and on the second day it spread to the body. The doctors felt the rash was due to phenytoin medication.
Could she have had measles at her age subsequent to the discharge from the hospital? Why did she have convulsions? Did the drugs chloroquine and ofloxacin caused the convulsions? Could anyone throw any light on the episode. She was withdrawn from phenytoin from 14 and is now on valproate sodium 200 mg tds. Are any other tests needed now to rule out future complications? Does she really need the anticonvulsive medication she is being given now?
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